BACKGROUND: We are sick and tired of being redisorganized. OBJECTIVE: To systematically review the empirical evidence for organizational theories and repeated reorganizations. METHODS: We did not find anything worth reading, other than Dilbert, so we fantasized. Unfortunately, our fantasies may well resemble many people's realities. We are sorry about this, but it is not our fault. RESULTS: We discovered many reasons for repeated reorganizations, the most common being 'no good reason'. We estimated that trillions of dollars are being spent on strategic and organizational planning activities each year, thus providing lots of good reasons for hundreds of thousands of people, including us, to get into the business. New leaders who are intoxicated with the prospect of change further fuel perpetual cycles of redisorganization. We identified eight indicators of successful redisorganizations, including large consultancy fees paid to friends and relatives. CONCLUSIONS: We propose the establishment of ethics committees to review all future redisorganization proposals in order to put a stop to uncontrolled, unplanned experimentation inflicted providers and users of the health services.

Journal Article↗

PubMed2006

Biased underreporting of research is unethical and should be outlawed.

Biased underreporting and multiple or selective publications of clinical trials harm and sometimes kill patients. Publicly funded researchers are not innocent of this form of scientific misconduct, but it is a particular problem in industry-sponsored research. So far, only six pharmaceutical companies have endorsed the "Good Publication Practice for Pharmaceutical Companies Guidelines". It is necessary to register all clinical trials publicly, at inception. Drug companies should be forced to publish all results, regardless of outcome.

Ethics, Research↗

PubMed2005

Are experimental treatments for cancer in children superior to established treatments? Observational study of randomised controlled trials by the Children's Oncology Group.

OBJECTIVES: To assess how often new treatments for childhood cancer assessed in phase III randomised trials are superior or inferior to standard treatments and whether the pattern of successes and failures in new treatments is consistent with uncertainty being the ethical basis for enrolling patients in such trials. DESIGN: Observational study. SETTING: Phase III randomised controlled trials carried out under the aegis of the Children's Oncology Group between 1955 and 1997, regardless of whether they were published. MAIN OUTCOME MEASURES: Overall survival, event free survival, and treatment related mortality. RESULTS: 126 trials were included, involving 152 comparisons and 36,567 patients. The odds ratio for overall survival with experimental treatments was 0.96 (99% confidence interval 0.89 to 1.03), indicating that new treatments are as likely to be inferior as they are to be superior to standard treatments. This result was not affected by publication bias, methodological quality, treatment type, disease, or comparator. CONCLUSIONS: New treatments in childhood cancer tested in randomised controlled trials are, on average, as likely to be inferior as they are to be superior to standard treatments, confirming that the uncertainty principle has been operating.

Child↗

PubMed2005

Bill Silverman: a personal appreciation.

Explore the source record for details and available documents.

History, 20th Century↗

PubMed2005

A surrealistic mega-analysis of redisorganization theories.

BACKGROUND: We are sick and tired of being redisorganized. OBJECTIVE: To systematically review the empirical evidence for organizational theories and repeated reorganizations. METHODS: We did not find anything worth reading, other than Dilbert, so we fantasized. Unfortunately, our fantasies may well resemble many people's realities. We are sorry about this, but it is not our fault. RESULTS: We discovered many reasons for repeated reorganizations, the most common being "no good reason". We estimated that trillions of dollars are being spent on strategic and organizational planning activities each year, thus providing lots of good reasons for hundreds of thousands of people, including us, to get into the business. New leaders who are intoxicated with the prospect of change further fuel perpetual cycles of redisorganization. We identified eight indicators of successful redisorganizations, including large consultancy fees paid to friends and relatives. CONCLUSIONS: We propose the establishment of ethics committees to review all future redisorganization proposals in order to put a stop to uncontrolled, unplanned experimentation inflicted on providers and users of the health services.

Consultants↗

PubMed2004